title: Critical analysis of the 4-hour A&E policys impact on elderly patients.
abstract: Government evaluations of the 4-hour waiting time policy show an overall improvement in accident and emergency (A&E) waiting times. However, the audit results shadow the policy's impact on age groups, which make it difficult to determine the policy's impact on older people, who are the largest and most vulnerable service users. Literature suggests that the policy has benefited the younger populace more than the older user group, who experience difficulties in other areas of the health system, both upstream through inappropriate ward admissions, incomplete assessments, poor care, and bed-access blocks while being held in clinical decision units as well as downstream, where ambulance staff are managing stacked patients outside A&E departments, causing ambulance delays to more vulnerable older patients in communities. While patient flow through A&E has improved, the upstream-downstream effect has disrupted patient flow through the remaining health system and communities, which has resulted in increased dissatisfaction and poor care mainly among the elderly population. This article examines the problems experienced by the elderly in A&E prior to the policy's introduction and its subsequent impact on older people following implementation, in order to determine whether the policy has improved or further deteriorated care towards this group.
authors.affiliation: Florence Nightingale School of Nursing and Midwifery, University of London, King's College, London, UK.
authors.forename: Waseem
authors.initials: W
authors.lastname: Munir
mesh_terms: D000368:Aged; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D006291:Health Policy; D006801:Humans; D016134:Organizational Policy